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UMHS External Counter Pulsation Treatment Program

External Counter Pulsation Treatment

What is ECP?

External Counter Pulsation (ECP) is performed as a non-invasive treatment to lower the number and intensity of angina episodes. Treatment is administered through three pairs of external inflatable cuffs that are applied around the lower legs, upper legs and buttocks These cuffs continuously inflate and deflate between the resting period of the heart beat and increase blood returned to the heart.


The basic principle of ECP treatment involves increasing the amount of blood returning to the heart, which helps supply more oxygen to it’s starved areas. With more oxygen available, the heart can function much more efficiently and therefore, reduce chest pain.

The treatment schedule includes 7 weeks of continuous treatments which require daily visits for 1 hour, Monday through Friday.

History of ECP Treatments
ECP treatment originated in China where it has been extensively used since the 1960’s. In the past 10 years it has been introduced to the United States, where there are currently around 1200 machines in operation. The idea for ECP, stemmed from the development of the intra aortic balloon pump (IABP).  IABP resulted in increasing the amount of blood that can get pumped out of the heart by inflating a balloon in the aorta between each heart beat. Opening up the aorta allows more blood flow and therefore decreased how hard the heart has to work. This same theory is applied to ECP but is taken one step further.  ECP Increases the amount of blood going back to the heart, providing more blood for the heart to work with. This also decreases how hard the heart has to work but on a much greater scale, especially for people with damaged heart tissue.

Who is Eligible for ECP Treatment?
Individuals are eligible for treatment if they have:


Hypertrophic cardiomyopathy Congenital heart disease
Valvular disease Enlarged heart
Pacemaker    Hemorrhage
Atrial fibrillation Pulmonary hypertension
Clot in their body Peripheral vascular disease
Severe elevated Blood pressure    Heart rate >120 bpm

What are the Benefits of ECP Treatment?

ECP Program Overview
Before beginning ECP treatment:

Nursing assessment
The nursing assessment will include a review of medical history, contraindications to treatment and clearing the individual for treatment.  During this assessment they will be given an angina diary which will be used to record frequency and duration of chest pain episodes.  During the nursing assessment, the individual will receive comprehensive information about ECP treatment, its procedures and will complete several questionnaires to assess severity of chest pain.

Stress test
Individuals will complete a stress test prior to beginning ECP treatment. This will establish their exercise capacity and provide final clearance to begin treatment.  More importantly, it will identify the severity, frequency and duration of chest pain with exercise.

After completing 35 treatment sessions, there will be another stress test measuring the same values. The two stress tests will be compared which will indicate any changes in chest pain and exercise capacity.

The orientation is designed to give an individual the chance to experience exactly what treatments will be like. There will be an orientation to the room, a full explanation of the treatment sessions, education about the treatment process, and a 15-minute trial of the ECP machine in operation. Any questions about the treatment will also be addressed at this time. The first official treatment session will begin the next day at a specified time.

Reviewed by Susan D. Housholder, RN, MSN, APRN, BC, FAHA, Nurse Practitioner/Clinical Director, CAD Management Program, Preventive Cardiology, January 2007